Jake Ermolovich is a Class of 2024 medical student at the UVM Larner College of Medicine. Having recently finished a clinical clerkship rotation in psychiatry, he wrote a reflection about the six weeks he spent at Champlain Valley Physician’s Hospital in Plattsburgh, New York and the lessons he will take from it into his future rotations.
Every reaction has a preceding action. We often see this is psychiatry. Personality disorders may result from childhood trauma or adverse childhood events. Substance use can be an attempt to force oneself to feel anything else – playing with molecules until they fit the spaces in our heads left damaged by an external experience, or left empty by a lack of experience yearned for. Anxiety can be a reaction to an action yet to happen.
All of these are manifestations of an ongoing battle with internal discomfort. Some people seek escape from pain through substance use and other methods that bring them back into its clutches, while others run towards it to stifle a pain from somewhere else. However, people can also learn from past painful events. In order to do so, they must delve further into the pain to gain a better understanding of it so that some form of control can be exerted over it. Unfortunately, re-exposing oneself to something so unbearable can cause further trauma, so having a guide is imperative to ease that burden.
This is what I’ve come to understand as the role of psychiatrists—to help patients mold trauma and painful experiences into something easier to work with and through.
Imagine that, as you listen to a patient tell their story, puddles of wet clay spill from their mouth. Even the things they don’t say seem to work their way into this clay. The clay lays all over the table, at times spilling past the confines of the table’s edge and onto the floor. It’s hard to control. It’s hard to contain. No wonder all that pain fell so swiftly from the mouth of the person before you – who could ever hold all that within?
Now, you sit in that room and take stock of these formless puddles of clay, these horrors around you, validating the suffering they’ve caused and continue to cause your patient. Then slowly, carefully, surgically, you take that malleable material and start to help the patient mold it. You sit together and work on building the amorphous blobs of clay into something – a protective obelisk- something solid and hospitable – a home of sorts. You and your patient work together until the foundation is formed. It can take a long time – for a house isn’t built in a day, and a home isn’t made until a person feels support within themselves and not just from others.
During my psychiatry clinical rotation, I came to recognize the importance of maintaining my own home. Consumed by my medical education, I have often been neglectful of my mental health house — my id igloo. But through careful introspection, I found that what my igloo lacked was someone else to hold a mirror up for true reflection. It was a lack of reflection that allowed a malady of disordered mood to fester, and as any aspiring physician is apt to do, I tried to remedy that sickness so my mind could heal. To do so, I let the patient hold the mirror up for me. I opened the gates and tried to be more open and honest with myself and how I feel, noticing how a patient’s story elicits a reaction within me. Then, I must carefully decide how that reaction will manifest therapeutically in the words I choose to share. Hopefully, that honesty with myself can transfer to trust, and that trust can build a bridge between mine and every other heady home that opens their gates to me.